5 ms·

Before I dive in, I want to say "size matters". Singapore is the size of a city in US, whatever works for them does not apply to US as a whole.

by ausjke 9y ago

kelnos 9y ago
I'm very tired of this argument that alway seems to get trotted out in an attempt to shut down discussion. I'd love to see a US state try to do some drastic health care reforms. CA has toyed with single-payer options, though it's hampered funding-wise by the federal government, and the fact that, despite popular appearances, CA has a large segment of conservative voters. Singapore and, say, South Carolina, have similar populations, so you'd expect to be able to implement Singapore-style healthcare on a state level if your only objection is population. In reality, though, consensus-building and lobbying dollars tend to be the biggest obstacles to US-wide reform.
dragonwriter 9y ago
> Singapore is the size of a city in US Well, a city, in that it's significantly larger than any city in the US other than NYC.
- bogomipz 9y ago
  If you count the city limits proper that would be true. If you count the agglomeration or greater city area which is what you are doing by saying all of Singapore then no, not by a long shot: https://en.wikipedia.org/wiki/List_of_the_largest_urban_agglomerations_in_North_America https://en.wikipedia.org/wiki/List_of_the_largest_urban_aggl...
  - dragonwriter 9y ago
    > If you count the city limits proper that would be true. If you count the agglomeration or greater city area which is what you are doing by saying all of Singapore then no, not by a long shot: Yes, if you said “Singapore is of similar size to a large metropolitan area in the U.S.”, rather than “...a city...”, then, yes, the comparison would be to a category where Singapore's population would be reasonably typical, rather than just shy of the biggest. But when you say “city”, it doesn't communicate something bigger than a city just because the thing you are comparing to a city is, itself, not just a city.
Eridrus 9y ago
This argument gets made constantly and it's a bit tiring. No-one is exactly the same as the US. This doesn't mean we can't learn from others.
gnaritas 9y ago
> I want to say "size matters" Saying it does't make it true. How about justifying why you think it matters? Because we can talk about any population in terms of percentage which factors out size. I suspect when you try and explain why size matters, you'll run into a better argument to make.
qaq 9y ago
why?
yardie 9y ago
So by economies of scale US health care should be dramatically cheaper. If you're saying that size matters without diving into it.
criddell 9y ago
And on the other end of the spectrum we have Canada which has a smaller population spread out over a bigger area. Both extremes are able to to deliver health care for less than the US. Surely there's a lot we can learn from both extremes.
qmr 9y ago
Because it always costs more per widget when you order 10,000 widgets instead of 100, right?
- jfoutz 9y ago
  Two conditions. Each widget is customized in a unique way, and 10000 exceeds the capacity for customization.
ausjke 9y ago
No,my point is that as a small country especially like Singapore, it is easier/more-flexible to optimize healthcare etc comparing to US, it is not as diversified as US population and thus much simpler to manage/plan/organize/control etc. While it definitely is a good example, many scheme there might not work at a large scale.
- tormeh 9y ago
  Politically, I guess it does. Half of the US would rebell if you tried to simply transplant the Singapore health care system to the US. The US is also more attractive for lobbyists because of its size. But economically it's obviously nonsense.
  - greeneggs 9y ago
    There are economic reasons why size matters. For example, Singapore is small enough that you can get to any hospital from anywhere. In many areas of the US, there are fewer accessible healthcare providers. (For example, less dense regions, or urban areas in which all the competing hospitals have merged.) Perhaps this doesn't matter if you want to set broad price controls or nationalize the entire industry. But under Obamacare, it has made insurers' lives more difficult.
- gnaritas 9y ago
  The only really valid point there is the culture one, which is actually our problem and the reason we're not already using socialized medicine country wide. It would work fine, everyone would be better off, but half the country would object based on their values regardless of it helping them.
- princeb 9y ago
  > it is not as diversified Singapore is not only more diversified than the US, it is the most extreme case of religious diversity in the world [1] [1] http://www.pewforum.org/2014/04/04/global-religious-diversity/ http://www.pewforum.org/2014/04/04/global-religious-diversit...
princeb 9y ago
the downmodding seems a tad unfair, given that the article also made a reference to size being an advantage: > Singapore is also very small, and the population may be healthier in general than in some other countries. It’s a little easier to run a health care system like that. but what I don't get is why so many people will simply say this without any further evidence that this is true. if size is a benefit, will a country with a population of 1 have an extremely efficient healthcare system? how about a country with a population of 10? obviously no. But does it get better at 1m people? 10m? 100m? I think the size of the US is a red herring, and there are so many other reasons why the US doesn't work, like the way the healthcare economy is structured, social contribution, population sprawl, etc that size offers no economies of scale advantage and in fact works against it. Under the right conditions, being larger really should help a healthcare system, not hurt it.
- MadSudaca 9y ago
  I think the problem is that there are many things that come with size. For example, a larger country is more heterogeneous, thus it's more likely that it'll be harder for people to agree on how to solve a particular issue. Also, I think most of the problems you mentioned would be ameliorated if the US had a smaller population.
  - yen223 9y ago
    It's weird to think of Singapore - a country with 4 official languages - as being homogeneous.
  - nradov 9y ago
    It's not the size per se, but rather the political system. If the USA had a federal executive branch as powerful as the equivalent in Singapore then getting people to agree wouldn't be an issue. (I'm not necessarily recommending this since it causes other problems.)
mbrodersen 9y ago
Each US state is a lot smaller than the US. So imagine for a moment each US state individually implements it. That is obviously possible. So following this thinking, that should make you realise that size (in this case) does not matter. Of course the US can implement something like this. Except that the US is a plutocracy and not a democracy => no political will.
- smallnamespace 9y ago
  > That is obviously possible It actually isn't in any simple fashion. What happens if state A implements health care much better than the state next door, so everyone flocks to state A and deluges the hospitals? Do you make so that only state residents get the 'state rate' for health care? What about the people who are stuck in the poor, badly managed states that get left behind?
  - gnaritas 9y ago
    You're entirely missing his point; imagine all states implement the exact same system, if that'll work, then it'll work for the nation as a whole, size is irrelevant. Yes, there are other factors at play, but he's addressing the size issue, not the other factors, so your objections are off point.
  - nradov 9y ago
    But some states already have implemented health care much better than the other states next door. We have a natural experiment occurring right now. And yet people don't seem to be flocking to those states. When you move your legal residence from one state to another you are considered a resident of that state almost immediately.

Before I dive in, I want to say "size matters". Singapore is the size of a city in US, whatever works for them does not apply to US as a whole.

by ausjke 9y ago

Before I dive in, I want to say "size matters". Singapore is the size of a city in US, whatever works for them does not apply to US as a whole.

kelnos 9y ago

I'm very tired of this argument that alway seems to get trotted out in an attempt to shut down discussion. I'd love to see a US state try to do some drastic health care reforms. CA has toyed with single-payer options, though it's hampered funding-wise by the federal government, and the fact that, despite popular appearances, CA has a large segment of conservative voters. Singapore and, say, South Carolina, have similar populations, so you'd expect to be able to implement Singapore-style healthcare on a state level if your only objection is population. In reality, though, consensus-building and lobbying dollars tend to be the biggest obstacles to US-wide reform.

dragonwriter 9y ago

> Singapore is the size of a city in US Well, a city, in that it's significantly larger than any city in the US other than NYC.

bogomipz 9y ago
If you count the city limits proper that would be true. If you count the agglomeration or greater city area which is what you are doing by saying all of Singapore then no, not by a long shot: https://en.wikipedia.org/wiki/List_of_the_largest_urban_agglomerations_in_North_America https://en.wikipedia.org/wiki/List_of_the_largest_urban_aggl...
- dragonwriter 9y ago
  > If you count the city limits proper that would be true. If you count the agglomeration or greater city area which is what you are doing by saying all of Singapore then no, not by a long shot: Yes, if you said “Singapore is of similar size to a large metropolitan area in the U.S.”, rather than “...a city...”, then, yes, the comparison would be to a category where Singapore's population would be reasonably typical, rather than just shy of the biggest. But when you say “city”, it doesn't communicate something bigger than a city just because the thing you are comparing to a city is, itself, not just a city.

Eridrus 9y ago

This argument gets made constantly and it's a bit tiring. No-one is exactly the same as the US. This doesn't mean we can't learn from others.

gnaritas 9y ago

> I want to say "size matters" Saying it does't make it true. How about justifying why you think it matters? Because we can talk about any population in terms of percentage which factors out size. I suspect when you try and explain why size matters, you'll run into a better argument to make.

qaq 9y ago

why?

yardie 9y ago

So by economies of scale US health care should be dramatically cheaper. If you're saying that size matters without diving into it.

criddell 9y ago

And on the other end of the spectrum we have Canada which has a smaller population spread out over a bigger area. Both extremes are able to to deliver health care for less than the US. Surely there's a lot we can learn from both extremes.

qmr 9y ago

Because it always costs more per widget when you order 10,000 widgets instead of 100, right?

jfoutz 9y ago
Two conditions. Each widget is customized in a unique way, and 10000 exceeds the capacity for customization.

ausjke 9y ago

No,my point is that as a small country especially like Singapore, it is easier/more-flexible to optimize healthcare etc comparing to US, it is not as diversified as US population and thus much simpler to manage/plan/organize/control etc. While it definitely is a good example, many scheme there might not work at a large scale.

tormeh 9y ago
Politically, I guess it does. Half of the US would rebell if you tried to simply transplant the Singapore health care system to the US. The US is also more attractive for lobbyists because of its size. But economically it's obviously nonsense.
- greeneggs 9y ago
  There are economic reasons why size matters. For example, Singapore is small enough that you can get to any hospital from anywhere. In many areas of the US, there are fewer accessible healthcare providers. (For example, less dense regions, or urban areas in which all the competing hospitals have merged.) Perhaps this doesn't matter if you want to set broad price controls or nationalize the entire industry. But under Obamacare, it has made insurers' lives more difficult.
gnaritas 9y ago
The only really valid point there is the culture one, which is actually our problem and the reason we're not already using socialized medicine country wide. It would work fine, everyone would be better off, but half the country would object based on their values regardless of it helping them.
princeb 9y ago
> it is not as diversified Singapore is not only more diversified than the US, it is the most extreme case of religious diversity in the world [1] [1] http://www.pewforum.org/2014/04/04/global-religious-diversity/ http://www.pewforum.org/2014/04/04/global-religious-diversit...

princeb 9y ago

the downmodding seems a tad unfair, given that the article also made a reference to size being an advantage: > Singapore is also very small, and the population may be healthier in general than in some other countries. It’s a little easier to run a health care system like that. but what I don't get is why so many people will simply say this without any further evidence that this is true. if size is a benefit, will a country with a population of 1 have an extremely efficient healthcare system? how about a country with a population of 10? obviously no. But does it get better at 1m people? 10m? 100m? I think the size of the US is a red herring, and there are so many other reasons why the US doesn't work, like the way the healthcare economy is structured, social contribution, population sprawl, etc that size offers no economies of scale advantage and in fact works against it. Under the right conditions, being larger really should help a healthcare system, not hurt it.

MadSudaca 9y ago
I think the problem is that there are many things that come with size. For example, a larger country is more heterogeneous, thus it's more likely that it'll be harder for people to agree on how to solve a particular issue. Also, I think most of the problems you mentioned would be ameliorated if the US had a smaller population.
- yen223 9y ago
  It's weird to think of Singapore - a country with 4 official languages - as being homogeneous.
- nradov 9y ago
  It's not the size per se, but rather the political system. If the USA had a federal executive branch as powerful as the equivalent in Singapore then getting people to agree wouldn't be an issue. (I'm not necessarily recommending this since it causes other problems.)

mbrodersen 9y ago

Each US state is a lot smaller than the US. So imagine for a moment each US state individually implements it. That is obviously possible. So following this thinking, that should make you realise that size (in this case) does not matter. Of course the US can implement something like this. Except that the US is a plutocracy and not a democracy => no political will.

smallnamespace 9y ago
> That is obviously possible It actually isn't in any simple fashion. What happens if state A implements health care much better than the state next door, so everyone flocks to state A and deluges the hospitals? Do you make so that only state residents get the 'state rate' for health care? What about the people who are stuck in the poor, badly managed states that get left behind?
- gnaritas 9y ago
  You're entirely missing his point; imagine all states implement the exact same system, if that'll work, then it'll work for the nation as a whole, size is irrelevant. Yes, there are other factors at play, but he's addressing the size issue, not the other factors, so your objections are off point.
- nradov 9y ago
  But some states already have implemented health care much better than the other states next door. We have a natural experiment occurring right now. And yet people don't seem to be flocking to those states. When you move your legal residence from one state to another you are considered a resident of that state almost immediately.